Upon report of poor affect, low contraceptive or condom self-efficacy, pregnancy desire, or desire for sex to regulate affect, participants receive tailored messages in their preferred voice and style (Shrier et al., 2020). Participants then complete 4 weeks of mhealth app reporting and messaging (4 times per day: 1 momentary report prompted at random within morning, afternoon, and evening time periods and 1 diary report at a scheduled time). At the session, participants prepare to use the mhealth app by downloading the app onto their personal smartphone and indicating their preferences for voice and style of the app messages (“app onboarding”). The intervention begins with an in-person “main” counseling session (~ 1 h) to elicit motivation for SRH behavior change and develop a plan for meeting behavior change goals, provide information on contraception and condoms, develop sexual communication skills, and teach cognitive restructuring. To address negative affect in relation to SRH behavior, MARSSI incorporates well-established cognitive behavioral therapy (CBT) techniques, including cognitive restructuring (identifying and challenging unhelpful thoughts) (Klein et al., 2007). Acknowledging that low motivation is a core symptom of depression, MARSSI employs a Motivational Interviewing (MI)–based approach to enhance self-efficacy for changing SRH behavior (Treadway et al., 2012). MARSSI is a counseling-plus-mobile health (mhealth) intervention to reduce unintended pregnancy and STIs among AYA women with depression (Shrier et al., 2020). In response to the lack of interventions that address both depression and SRH, a multidisciplinary team of adolescent health professionals developed the Momentary Affect Regulation – Safer Sex Intervention (MARSSI). As a result, AYA women with depression have a disproportionately higher risk for adverse SRH outcomes, including unintended pregnancy, unintended first birth, and sexually transmitted infections (STIs) (Hall et al., 2014 James-Hawkins et al., 2014 Lee et al., 2009). They are also more likely to report no or inconsistent contraceptive use and less likely to report using long-acting reversible contraception (LARC) (Hall et al., 2013, 2014). AYA women with depression are more likely to engage in risk behaviors like condom non-use, sex with multiple partners, and sex under the influence of substances (Foley et al., 2019 Jackson et al., 2015 Shrier et al., 2009). Expanding delivery options for SRH interventions to include virtual can improve access, particularly for populations with psychological and environmental barriers to care.Īdolescent and young adult (AYA) women with depression have pronounced sexual and reproductive health (SRH) risk compared with their non-depressed counterparts (Hensel et al., 2016). Participants experienced minimal technical difficulties and expressed satisfaction with the virtual format, and all were able to complete app onboarding successfully. After testing the virtual format in mock sessions, we implemented a small-scale feasibility study in an adolescent medicine clinic with women with depressive symptoms and high-risk sexual behavior age 18–24 years ( N = 9). Instructions and programming were developed to support virtual counseling delivery and onboarding for the mhealth app component of MARSSI. Virtual counseling retained key elements from in-person counseling while including enhancements with engaging visual and audio–video aids. We identified essential aspects of the counseling, specified the content so the counseling could be delivered in person or virtually with fidelity, and considered best practices for telehealth for the focus population. A team with SRH, adolescent medicine, motivational interviewing, cognitive behavioral therapy, and technology expertise adapted the counseling through an iterative consensus process. Due to the COVID-19 pandemic limiting in-person care, we sought to develop the counseling and mhealth app onboarding for virtual implementation.

MARSSI (Momentary Affect Regulation – Safer Sex Intervention) is a counseling-plus-mobile health (mhealth) intervention to reduce sexual and reproductive health (SRH) risks for women with depression and high-risk sexual behavior.

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